Provider Demographics
NPI:1760669576
Name:IDCZAK-KRENZ, BARBARA
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:
Last Name:IDCZAK-KRENZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SPROUT BROOK RD
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10524-7464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 SPROUT BROOK RD
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:NY
Practice Address - Zip Code:10524-7464
Practice Address - Country:US
Practice Address - Phone:845-739-9241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016039-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist